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Appendix Vill 265632 <br />Underground Storage Tank <br />Spill Container Testing Report Form <br />TYPE OF ACTION Installation ❑Repair 712 Month <br />1. FACILITY INFORMATION 71 <br />CE RS ID <br />10977436 <br />Test Date <br />6/18/2025 <br />Facility Name <br />Arco 7193 <br />Facility Address <br />9036 Thornton Rd. <br />City <br />Stockton <br />ZIP Code <br />95209 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test Phone <br />Nwestco LLC 925-551-7444 <br />Mailing Address <br />6805 Sierra Court, Suite G, Dublin, CA 94568 <br />Service Technician Performing Test <br />Robert Jacobs <br />Contractor/Tank Tester License Number <br />1073967 <br />ICC Number <br />8819943 <br />ICC Expiration Date <br />8/31/2026 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />bPW UST EVR Phase 1 Tech Cart ##0177621 <br />1/5/2027 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />1 Hour Hydrostatic <br />All Spill Buckets <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />1 hereby certify that each spill container was tested in accordance with California Code of <br />Regulations, title 23, division 3, chapter 16, section 2637. a; that required supporting <br />documentation is attached; and all information contained herein is accurate. l understand <br />that test procedures shall be made available upon request by the governing authority. <br />Service Technician Signature K--� <br />Date <br />6/10/2025 <br />Total # of Pages <br />2 <br />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council <br />Page 1 of 2 <br />